Healthcare Provider Details

I. General information

NPI: 1073640264
Provider Name (Legal Business Name): NORTH GEORGIA OPTICIANS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 03/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 JESSE JEWELL PKWY SE SUITE C
GAINESVILLE GA
30501-3772
US

IV. Provider business mailing address

535 JESSE JEWELL PKWY SE SUITE C
GAINESVILLE GA
30501-3772
US

V. Phone/Fax

Practice location:
  • Phone: 770-534-1711
  • Fax:
Mailing address:
  • Phone: 770-534-1711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. LARRY JEFFREY PAYNE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 770-534-1711